HomeMy WebLinkAbout1518 Fairway Seven Ct - Applications/Water Heater - 05/25/2012MAY-25-2012 15:54 From:Allen Service 970 484'4448 1 To:92246134 Page:3,'10
City of art Collins
Planning, Development & Transportation
281 N. College Ave P.G. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -THE -COUNTED PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) to Gas Lighter Q Gas Log
❑ Heating Unit O Lawn Sprinkler 11 Mobile Home replacement ❑ Roofing ❑ Sewer line ❑ Photo -voltaic
O Ventilation +later Heater ❑ Water Line ID Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # gi,IZ.o e)�✓j�u Y Date -5 )6 /a
For office use onb
Job Site Address freaui ) Value of Construction (labor, materials, profit)
Property OwnerN/�ame Address GtY/State Zlo Phone
f' I . A - I. _new 4A"A , n -�I—Mo
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Address City/State Zip Phone
cantNamer r � hr i i k � E11 S i,i 1A cUllx sS/
Contractor Address City/State Zip Phone
Aib�n�� ('oI rt�C'Q �osmy'
Report
Contractor city of Ft. Collins Sales Tax Are you paying taxes,hcre or by report? ❑ Here 0 No
Sates tax number & reouired by od cnnkwtars. Are you paying with your trust account? Yes No
Is this a residential or mmerdal project? Idential ❑ Commercial
If residential, Is it: Single Family Deta ed COCondo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical offce • ❑ Office ❑ Retail
13 Restaurant Q Other (exkall)
Is this building 5o years of age or more? 17 Yes o IfyesyoumayneedtocontactMistorlcPreservation
If this is for a demolition permit, what year was thIlding constructed?
It prior to 1975, you will n7r an asbestos assessment to submit with th/s appleavon.
Description of work
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, mud list licensed electrician.
Subcontractors: List the company name or Oily of Ft Collins license 0
Electrician Plumber Mechaiucai Roofer. Other
1 hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant:�Qrrf lJl 1n - Date
Print Name. Signatur